Theology for PMADs: Part 1 – The Doctrines of God, Scripture, Providence, and the Trinity

I use the hashtag #theologyforpmads on Instagram to make it easy to find my posts on perinatal mood and anxiety disorders. This isn’t just to have a unique hashtag no one else is using. The application of theology to PMADs has been one of the greatest helps to me in understanding and recovering from perinatal depression, anxiety, PTSD, and OCD. Our understanding of God, His Word, providence, evil, man, sin, the person and work of Christ, the Holy Spirit, salvation, the church, and even eschatology informs how we suffer, how we interpret the world around us, and how we seek help.

My focus on theology is not intended downplay the importance of proper medical care. But there’s already a lot out there addressing PMADs from that angle.[1] What I want to do is bring theology to bear on PMADs for a distinctly Christian understanding of them, so that Christian women with PMADs and their support teams can be better equipped. Much of what I write will also hold true for general mood and anxiety disorder and other suffering we face.

Over the next few weeks, I’ll post about various topics of theology and how they apply to PMADs. Some of these doctrines can be controversial, but I’ll only be scratching the surface of them and will be trying to write in a way that won’t stir up needless controversy.  

What does the doctrine of GOD have to do with PMADs?

Who do we think God is? What do we think He is like? How is He at work in the world? Books can’t fully explain God, so an Instagram post definitely can’t. Because of this, I’m just going to touch on three aspects of His nature here.

Transcendence.
God is the “other than King,” to borrow Ryan Lister’s phrase.[2] This points to His power, holiness, and authority, something that is terrifying outside of Christ, but comforting to His children. God is powerful enough to work in your suffering, even to remove it. He’s the Creator, not a creature, and doesn’t have the weaknesses and finite limitations we do. We won’t always (even usually) understand how He is working, because God doesn’t fit in our little boxes.

Immanence.
At the same time, God is the “with you King.” His transcendence doesn’t make Him standoffish; He manifests His nearness in Christ and in the Holy Spirit to help you in your time of need.[3] He is with you in your suffering, but can also rescue you from it.

Lovingkindness.
We may look at God’s transcendence and ask questions about evil and providence. But His immanent lovingkindness show that God’s work in the world and our in lives answers that problem.

If we truly believe that God is lavishly good, loving, and kind to those His Son has saved (as He demonstrated by giving up His Son for our adoption), it won’t remove our PMADs, but it will increase our courage and trust as we suffer.

In the comments: book recommendations on the character of God and two quotes highlighting how important our view of God is.

Book Recommendations:
“God Is” by Mark Jones
 “In His Image” and “None Like Him” by Jen Wilkin
(but there are many other good ones!)

“When the surrender of ourselves seems too much to ask, it is first of all because our thoughts about God Himself are paltry. We have not really seen Him, we have hardly tested Him at all and learned how good He is. In our blindness we approach Him with suspicious reserve. We ask how much of our fun He intends to spoil, how much He will demand from us, how high is the price we must pay before He is placated. If we had the least notion of His lovingkindness and tender mercy, His fatherly care for His poor children, His generosity, His beautiful plans for us; if we knew how patiently He waits for our turning to Him, how gently He means to lead us to green pastures and still waters, how carefully He is preparing a place for us, how ceaselessly He is ordering and ordaining and engineering His Master Plan for our good – if we had any inkling of all this, could we be reluctant to let go of our smashed dandelions or whatever we clutch so fiercely in our sweaty little hands?” (Elisabeth Elliot, Loneliness, page 102)

“Wimpy theology makes wimpy women… Wimpy theology simply does not give a woman a God that is big enough, strong enough, wise enough, and good enough to handle the realities of life in away that magnifies the infinite worth of Jesus Christ. Wimpy theology is plagued by woman-centeredness and man-centeredness. Wimpy theology doesn’t have the granite foundation of God’s sovereignty or the solid steel structure of a great God-centered purpose for all things.” – John Piper

What does the doctrine of SCRIPTURE have to do with PMADs?

This is a foundational doctrine. If we don’t view Scripture as the living and active Word of God, sufficient for faith and practice, then no other doctrine has a firm foundation—even the doctrine of God.

But I didn’t start with here, because thinking about the Bible can make new moms feel guilty. We can’t find the time to read it, or our foggy brains make it so difficult we give up. Depression may even block Scripture’s comfort. I’m not going to give you rules about how or how much to read. I hope rather to help you wonder at what a gift it is and encourage you to let it form your thoughts about PMADs.

1. Scripture is a gift.

We’re so used to our Bibles that we take them for granted. Having personal copies in our language is a privilege. But the existence of the Bible is an even greater privilege, because it is God’s communication to sinful men and women. He is reaching out to rebels. And that’s not just something He did long ago. According to Timothy Ward, “Whenever we encounter… Scripture, we encounter God himself in action. The Father presents himself to us as a God who makes and keeps his covenant promises. The Son comes to us as the Word of God, knowable to us through his words. The Spirit ministers these words to us, illuminating our minds and hearts, so that in receiving, understanding and trusting them, we receive, know and trust God himself” (pg. 95, Words of Life)

2. Scripture should shape how you think about PMADs.

The Bible should impact how we process and address PMADs—not just with specific verses, but with systematic and biblical theology. Scripture isn’t going to tell you what medication to take. But it will “thoroughly equip you for every good work,” and give you a worldview to understand your suffering and a framework for wisely seeking healing. Make use of God’s great gift!

(For more on the doctrine of Scripture, read Psalm 19, and look at R.C. Sproul’s free e-booklet “Can I Trust the Bible?”)

What does the doctrine of PROVIDENCE have to do with PMADs?

Providence: God’s direction of the world.

It’s often hotly debated. And it can make God seem dangerous—even evil—when divorced from an understanding of His goodness.

Christians disagree on exactly the role God plays in ordaining and governing our lives. Some say He only allows suffering in our lives, while others say He ordains it. But if God is God and there is none greater than Him, then everything comes back to Him, whether He ordains or merely allows.

This is why we ask God “why?” in our suffering. We know He has reasons for what we are going through, but we wonder how He can love us if He lets PMADs happen to us. He could have stopped them. He could have said “no.” Instead, He seems to say “no” to our prayers for relief.

Yet He permits—or ordains—what He hates to accomplish what He loves, to quote Joni Eareckson Tada.

This is terrifying, because it means that even our worst could happen. We don’t want to think anything good could ever come out of our worst. We don’t understand how blessing could ever come from PMADs.

I don’t know what good will come from your struggles. I can’t tell you how long it will take for you to be able to look back and say good did come (it took me a few years).

But we have to note the first part of the quote—God uses what He hates. What He hates. When God ordains or allows our suffering, He doesn’t do it glibly. He doesn’t rejoice in our pain. God using our PMADs doesn’t make them good.

But GOD is good. And it is because God is good that good can come from our trials and that we can trust Him to bring life from death, good from evil, and healing from pain. 

I know that’s not always comforting when you’re suffering. His goodness and providence don’t always make sense from our perspective. That’s where lament comes in, where we can freely and honestly cry out to Him, asking why and waiting for His comfort.

Our sanctification is a part of His goodness. He is good—but that goodness may be seen in his prying your grip off your idols. He’s not “safe,” but He is good.

Book recommendation: The Creaking on the Stairs, Mez McConnell.

What does the doctrine of the TRINITY have to do with PMADs?

Disclaimer: There will be no shamrocks in this caption.

The mystery of the Three in One and One in Three can’t really be addressed in an Instagram post. So instead, I’m going to share a few quotes from Fred Sanders’ book “The Deep Things of God,” that talk about how the Trinity impacts the gospel and how the gospel allows for us to be welcomed into the love and fellowship of the Triune God.  

Quoting Rainsford, Sanders demonstrates how the Trinity is necessary for salvation: “Thanks be to God, I have them all, and I want them all—Father, Son, and Holy Ghost. I read that my Heavenly Father took my sins and laid them on Christ… Then I want the Son, who ‘His own self [bore] my sins in His own body on the tree.’ And I want the Holy Ghost: I should know nothing about this great salvation and care nothing for it if the Holy Ghost had not come and told me the story, and given me grace to believe it.”

The Trinity doesn’t just relate to how our salvation is accomplished, but also to its end:

“The good news of the gospel is that God has opened up the dynamics of his triune life and given us a share in that fellowship.”

“The eternal life of God in himself is something ‘even better than the good news.’”

“The triune God is a love infinitely high above you, eternally preceding you, and welcoming you in.”

“The living God binds himself to us and becomes our salvation, the life of God in the soul of man. We are saved by the gospel of God to worship the God of the gospel.”

Ponder today what love we receive, what help we have, and what fellowship we can partake in, even amidst PMADs!

(For more: “Delighting in the Trinity” by Michael Reeves or “The Deep Things of God” by Fred Sanders)

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[1] See www.postpartum.net, Kristina Cowan’s book “When Postpartum Packs a Punch,” Karen Kleiman ‘s book “This Isn’t What I Expected,” and “The Postnatal Depletion Cure” by Oscar Serralach.

[2] Emblems of the Infinite King

[3] Immanence is an attribute; thus, He can’t be MORE immanent than He is, but it can be manifested or experienced differently, especially in relationship to His covenants. All of this on immanence/transcendence was heavily influenced by The Presence of God by Ryan Lister.

The Hardest, Most Necessary Place to Be

When I had postpartum depression, I didn’t want to go to church.

But I went, week after week, and something happened.

Read more in my post at Her View From Home.

Summer 2021

I love the layers in this nest.

Forget the play structure, in July and August the park is for blackberries.

And the backyard is for tomatoes!

Vacation time! We took a road trip to Eastern Washington and then to see my grandparents.

the alphorn in Leavenworth

feeding the cows my grandma boards

it was my grandparents’ 60th wedding anniversary, so we pulled out her wedding dress (that my mom also wore) and my younger sister and I tried it on.

We came home to twenty pounds of tomatoes.

a quiet morning at the library.

And a trip towards the mountain with friends.

And, finally, my girls on the same kind of carousel I grew up riding.

memorization// I memorized Isaiah 40 a few years ago, but am trying to get it to where I can recite it without prompts.

favorite recipes//
tasty fresh salsa
delicious cake (and I’m not usually a cake lover)

best of online// 
1. Two women I follow on Instagram did a grace-filled postpartum series. My favorite posts were this one, this one, and this one.
2. I finally found the arrangement of God of Our Fathers I played at camp one year.
3. I love this vision in buying a run-down house.
4. artists and the pit of despair
5. this sermon series on Isaiah 40
6. Charlotte Mason Fact Check
7. Did God change at the incarnation? (another take here)
8. social media and trying to be God
9. ice skating to Empty Chairs at Empty Tables
10. helpful article on perinatal OCD (warning: he does mention specific intrusive thoughts)
11. This podcast on mental health and the gospel.

reading of late// I read a lot this summer. My goal for 2021 was 60 books (trying to cut back to average 5/month), but I hit that by the end of July.
July reads:
Harry Potter and the Half Blood Prince
Character Matters (Menikoff)
We Will Not Be Silenced (Lutzer)
From Every People and Nation (Hays)
Harry Potter and the Deathly Hallows
My Last Name (Schumacher)
The Techwise Family (Crouch)
Russia’s Man of Steel (Marrin)
Sir Gawain and the Green Knight, Pearl, Orfeo (trans. Tolkien)
On God and Christ (Gregory of Nazianzus)

August reads:
And It Was Beautiful (Tippetts)
Ourselves (Charlotte Mason; I’ve been reading it since early in the year)
The Imitation of Christ (Thomas a Kempis; I’ve been reading it since early July)
Dragonfly (Meacham)
None Greater (Barrett)
The Promise is His Presence (Marshall)
The God Who Is There (Schaeffer)
Little Britches (Moody; aloud to Ezra and the girls in the car)

Paged through The Autobiography of Malcolm X, Fault Lines, and The Body Keeps the Score.

what brings joy// hugging family // 60 years of marriage for my grandparents // surprises // a fast computer // quiet mornings at the seminary library // toddlers in sunshine // cousins // gramma’s house //

The Munchkins// have been an exhausting delight this summer. We’re looking forward to getting back into a better routine, but the break and more time outside have been welcome.

writing// The Presence of God in Our Pain (guest post, a re-work of two old posts from my blog). I was also a guest on The Dark Side of the Full Moon podcast sharing about my PMADs. You can listen to that here.
Also, I’ve started an email list (I promise I won’t spam you!) and you can subscribe to that here. It’s different than subscribing to my blog via wordpress.

Book Review: Harry Potter

I had no interest in reading Harry Potter when I first heard of the series. I didn’t want to read anything that glorified magic, and at the time, I thought it was a moral issue.
Long arguments with a friend softened my position, and when I was about 19 I picked up the first book in the library. I read for about an hour, then put it back and walked away. It seemed really juvenile.

Another friend later told me that the books “grow with” the kid characters’ ages, so that as the series went on, they got better. This year, I heard people talking about how you really have to push through the first two or three books. I needed more fiction, so decided to try Harry Potter again.

I was amused enough by the first two books to keep reading, and by book four, I was hooked (so hooked that I would read one in a couple of days and it was hard to do anything else).

The series as a whole:

Rowling has built an interesting, well-rounded, believable world. I think that’s what’s made the books so engrossing for me. That, as well as the professors’ characters. They were all vibrant and quirky. While McGonagall and Dumbledore are by far my favorite characters (followed by Neville and Molly), Snape’s story was what drove me to read more than anything else. The kids often annoyed me, especially when there was teenage drama in later books. But at the same time, their irritating quirks and immaturity is part of what makes them seem so real.
I think Rowling’s pacing is also superb. She writes such long books, but except for The Order of the Phoenix, they never dragged or felt too long. I’m sure that’s due at least in part to how complex her plots are and how many secondary characters she has.

However, except for the last book, Harry’s a bit of a jerk, and there are definite allusions or ripoffs from Lord of the Rings which makes them lose some points for me.

Individual book reviews:

Since they’re so popular, I’m probably harder on them than I would be on other books since I had high expectations.

1. Harry Potter and the Sorcerer’s Stone
   I enjoyed it, though I can still tell why I put it down. The plot was great, characters were fine, but it really does read more like juvenile fiction, so enjoyable, but not something I’d rave about.
2. The Chamber of Secrets
   The pacing of this book and the world Rowling has created are great. The plot is mostly enjoyable, the writing, decent. The characters are a mix – I love the professors and Weasleys and find them believable and great characters. Hermoine is endlessly irritating, Harry is flat. The plot is essentially 12-year-olds breaking rules and refusing to involve professors while fighting evil… in a plot very similar to the first book.
3. The Prisoner of Azkaban
   It’s a step up in plot and character development from book #2. Definitely more intense and darker as well. Past a certain point I had a hard time putting it down.
4. The Goblet of Fire
   I thoroughly enjoyed this one; this series definitely improves as it goes on. That said, I still find the kids’ characters to be a bit flat and was rolling my eyes a bit at times because I agree with Ron about Harry getting all the attention (but the books do bear his name, so…).
   But the professors’ characters continue to draw me in more than anything else, and that ending – wow (I think the ending makes it my favorite book, but after having read them all, 6 and 7 are up there, too).
5. The Order of the Phoenix
   Thus far I’ve found that Rowling’s pacing has been superb and none of the previous Harry Potter books have dragged. This one, however, was painful to get through. In part, that was due to the circumstances of the book, which are naturally quite painful so I didn’t get frustrated at that. But up until the ending, the whole book just felt like filler and transition to get us from one point to another. It just dragged and didn’t have me as wrapped up in the story as the other books have.
6. The Half-Blood Prince
   I think this is Rowling’s best work so far. The kids’ characters are much more rounded out, there are so many questions you have to keep reading for, and even some surprises. Dumbledore becomes more “human” but his wisdom is also revealed further. Still, I found it less striking than the ending of #4, and all snogging teenagers was just too much. But, I cried.
7. The Deathly Hallows
   What a finale.
   I loved finally getting Snape’s backstory. I loved finally getting more character development in Harry. I loved the surprises/twists (some of which I had figured out ahead of time, but others caught me completely off guard). And the whole last few chapters were just incredible. Rowling weaved such an intricate story and it paid off wonderfully.

I did find sections like Snape’s backstory and other lengthy history/background dialogue to be disruptive, but I don’t know how else it could have been done without spoilers.

The question of magic:

Coming back around to the question of magic that kept me from reading Harry Potter to begin with, I am still concerned about that aspect of the books.

Yes, Gandalf does magic, too, but one could argue that it’s very different from witchcraft. Even if it isn’t, magic isn’t pervasive in Lord of the Rings. It’s not what the book is about.

No, I’m not worried about getting interested in witchcraft after reading the books. I am concerned with how normal it makes witchcraft seem, as it’s the whole foundation of the books. With the series being so long, you’re also very immersed in it for a good while. The dark magic in it is very heavy, and yet, we need to remember that all witchcraft is that, too. I also don’t think I’ll be watching the movies as the thought of watching them do magic still makes me uncomfortable.

I don’t know yet when we’d let our kids read them, if they’ll even still be popular when our kids are old enough (they’re good, but I don’t think they’ll stand the test of time like Tolkien and Lewis). If they do, I’d love to have conversations with them about magic, witchcraft, and even more, the redemptive themes of love, death, and eternal life.

3 Reasons Not to Read Fiction and 2 Reasons I Still Do

In high school, I loved a good theology book, but mostly read fiction. When I started to read more again after our kids were born, that flipped. I read almost exclusively theology for a few years. Recently, I’ve started to pick up more fiction again, and have discovered three reasons why I don’t read more fiction, but two reasons I should keep diving into stories.

Three Reasons I Don’t Read More Fiction

1. I have picky taste.

I’ve often had a novel recommended to me only to find that it really doesn’t suit me. Sometimes I can’t figure out why, but often it’s because I have little tolerance for relational drama (It’s not a book, but I couldn’t handle the backstabbing and blackmail in Downton Abbey). I also don’t like romance to be the main storyline which automatically rules out quite a few novels. Action tends to be a bit better, but really what I want is character development and depth.

My personal taste is very different from most people’s, which makes it hard to find fiction I will like, and I’m sure that many of the novels I recommend won’t be to your taste. There’s nothing wrong with that; it just makes it harder to read fiction consistently (especially if I had a bunch of no-go’s in a row!).

2. I become more anxious.

Generally speaking, in order to have narrative tension, bad things have to happen. So I’ve found that if I’m reading too many novels or if certain things happen in a novel, I start becoming more anxious, imagining or expecting bad things to happen. Nonfiction books can do this, too, but while a theology book may get me stirred up if it’s poor theology, it doesn’t usually cause me to worry more.

3. I have limited time.

This goes back to being picky and not wanting to waste time on a novel I don’t end up liking. But it also applies to books I do like—I’ve been reading Harry Potter this year and while I have mixed feelings about it, all I want to do is read when I’m in the middle of one of them. This keeps me up late or leads me to neglect other duties.

But there are plenty of good reasons to read fiction. Here are my top two.

Two Reasons I Continue to Read Fiction

Even with all of those reasons to not read fiction, I’m going to continue making it a priority.

1. Reading fiction is good for relaxation.

If I’m stressed or have been reading a lot of theology lately, novels are nice to let my mind unwind a bit. I especially like to have a good novel on hand if I’m taking a harder class or we’re going on vacation. I prefer theology, but not every day or moment is one for stretching my brain.

2. Stories are powerful.

At times, stories can teach and challenge us more than nonfiction does. They cut more directly to our affections and make us long to be like certain characters. They show us what certain character qualities look like in action. And they can reveal deep theological truths in ways that speaking more clearly doesn’t. It’s rare that I find a new novel that really moves me, but last year I read “The Door on Half-Bald Hill” by Helena Sorenson and I walked away from it thinking “This is why I read fiction.”

My favorite fiction:
The Lord of the Rings (J.R.R. Tolkien)
The Lost Princess (George MacDonald)
The Chronicles of Narnia (C.S. Lewis)
The Hawk and the Dove series (the first four; Penelope Wilcock)
The Door on Half-Bald Hill (Helena Sorenson)
Castaways of the Flying Dutchman Trilogy (Brian Jacques)
The Scarlet Pimpernel (Baroness Orczy)
Les Miserables (Victor Hugo)
A Tale of Two Cities (Charles Dickens)

Our First Year Homeschooling

 

 

 

 

 

 

 

 

 

 

We just wrapped up our oldest’s 1^st grade year.

In these pandemic times, we have to note that homeschooling has been the plan all along. We did a light kindergarten last year, in which our main goal was to get her used to me picking books and asking her to participate in certain things. I naively assumed that 1^st Grade would go roughly the same as kindergarten had.

Nope.

Our first 12-week term felt like it was all about her learning how to learn. How to try what she thought she’d fail at. How to accept correction. How to do what I asked, even when she thought a different way was better. How not to fling herself on the couch wailing when she wanted to give up. (All this while a one-year-old was buzzing around wreaking havoc.) There were a lot of tears, and I often despaired and wondered how I could best help her. I also frequently questioned curriculum choices.

Our second term, after a long Christmas break, was much improved, but we were progressing at a snail’s pace. Still, she was more teachable and engaged in school. I reminded myself frequently that whether or not we finished books didn’t matter.  

Our third term was much smoother and much more enjoyable. We’ve found rhythms that work better for us, and the ways of learning have started to click for S. It’s amazing to look back and see how she’s grown, not just in what she knows, but in her character as well. I’m grateful for the curricula choices we made.

Many days the “feast” felt rejected, but then I would be caught off guard by her recognizing a song on the classical radio station, asking to paint a nature find, reciting a poem, or piping up with some random story from history.

We still have a long way to go—not just because she has 11 years of school left! My patience is lacking, and we still have days where I have to coach her through her desire to give up. Narration is a foundation of our method, and we have not done well at it. She struggles with it and so unless it’s a really good day I often avoid it and find other ways for her to engage with the material. I know it’s a learning curve, but I hope to make that a priority for our school year next year, along with more Scripture memorization. 

I was also convicted at how many times I just wanted to get through the day or was content with a discussion of facts of our Bible reading, instead of really aiming at her heart and desires and true discipleship. She needs Jesus and so do I!

(Also, with 3 12-week terms not fitting nicely into the American schedules, we timed our 2-week term breaks to be with Ezra’s school breaks, as well as taking a 1-week break every 6 weeks for everyone’s sanity.)

Our core books:
Bible: we read Genesis and Matthew from the CSB
Math: Charlotte Mason Elementary Arithmetic Book 1*
History: The Story of the World + Famous Men of Ancient Greece and Famous Men of Ancient Rome
Reading: My Little Robins’s Treadwell Reading lessons with Treadwell Primer and First Reader
Literature: Aesop’s Fables (S actually initiated narrating these every time!)
Foreign Language: Alef with Beth on YouTube
Natural History: Living Things for Lively Youngsters (a lovely book; we did skip/edit a few things for evolution)
Handicraft: Origami, tying shoes, braiding
Geography: Charlotte Mason’s Elementary Geography, Children of Foreign Lands 
Music: we started out with Mrs. Curwen’s preliminary piano lessons, but I quickly realized S wasn’t ready and we switched to Sing Solfa instead.

Our poets: A.A. Milne, Cecily Mary Barker, Robert Louis Stevenson
Our artists: Winslow Homer, N.C. Wyeth, Norman Rockwell
Our composers: Aaron Copland, W.A. Mozart, Robert Schumann

*This was my biggest question in curriculum choices. I LOVE the ideas behind it, but we had a hard time with it and I did end up doing more written work for her, teaching borrowing and carrying once she grasped it with the manipulatives, and adding in other “math” stuff like time, measuring, etc. In the end, I do love the book, but I think the tweaks were necessary for S.

Supplementary books we loved:
The Big Picture Story Bible (David Helm)
The Biggest Story (Kevin DeYoung)
Kay Winter – Voices of Ancient Egypt
The 5,000-Year-Old Puzzle (Claudia Logan)
The Great Pyramid Elizabeth Mann
Mummies Aliki
Children’s Homer.
City by David Macaulay
Boy of the Pyramids by Ruth Fosdick Jones
nature books from the library, mostly on trees, birds, and wildflowers.

Read-alouds:
The Lost Princess (MacDonald)
The Ordinary Princess
Rainbow Garden (Patricia St. John)
Treasures of the Snow (Patricia St. John)
The Secret Garden
Swallows and Amazons
The Little Bookroom (Farjean)
Anna Hibiscus
Dangerous Journey

Our style is very Charlotte Mason influenced, mostly from the A Delectable Education podcasts and information, but we did change a few things to fit our family, especially in how often we did certain subjects.

We’ve taken this whole month of August off and are plunging back in to 2^nd Grade after Labor Day!

The Right Diagnosis

Last month, I finished up a round of physical therapy. My doctor referred me to PT, suspecting my occasional abdominal discomfort was caused by muscle weakness.

The physical therapist saw what was wrong before I had even sat down in the exam room. The issue wasn’t what my doctor thought, but that my hips were out of alignment. They probably had been for four years, since I’d had similar pain in my second and third pregnancies, but it was brushed off as round ligament pain.  The pain was gone within weeks, and I also realized I’d been experiencing related muscle fatigue almost all the time.

I had almost done an at-home program instead of going to a physical therapist. That would have done nothing to solve the problem. Likewise, my months of trying to fix the problem myself had gone nowhere, because it wasn’t the problem at all.

As anyone who’s been given wrong or elusive diagnoses before knows, the right diagnosis is so important.

It’s the same with perinatal mood and anxiety disorders. Just like with physical therapy, different diagnoses are going to mean different treatment and will point to different causes or possible causes. There’s much that’s going to be the same for all PMADs. Nutrition, exercise, and sleep help with all of them. Counseling is easily tailored to individual symptoms, even if PMADs are un- or wrongly diagnosed. But medications and medical causes are going to vary with different PMADs. Also, while we can treat what isn’t fully understood, the more a supporter and sufferer understand about what she’s going through, the more effective treatment is and the more quickly she will heal.

For three years, I though I had had severe but brief postpartum depression after our first was born. No one had told me my intrusive thoughts weren’t actual thoughts of harm, although because of how I was treated, it’s apparent that others knew they weren’t. I finally got a right diagnosis of OCD while studying more about PMADs when our second was a year old. I hadn’t had thoughts of harm; I’d had intrusive thoughts. Rather than severe depression, I had had mild OCD.

In some ways, that distinction didn’t matter. I had been successfully treated even with a wrong diagnosis. But had I understood my PMADs properly, I wouldn’t have been so anxious about having them a second time. Mild OCD is far less scary and dangerous than severe depression. They also have different roots, with OCD based closer to anxiety.

The variety of the PMAD spectrum is also why I say “perinatal mood and anxiety disorders.” Postpartum depression is often used as an umbrella term for all PMADs. It is shorter and clearer, since most people know what “postpartum” and “depression” mean. Perinatal mood and anxiety disorder is a mouthful, and they’re less commonly used words. But only saying “postpartum depression,” leaves moms who are pregnant and/or have anxiety, OCD, PTSD, bipolar, and psychosis feeling alone and unsure about whether anything is wrong or what can be done about it. I’ve had mothers who had prenatal depression tell me that they assumed postpartum would be horrendous because they were already so depressed, only to have the depression clear immediately after the birth. They thought that depression and pregnancy couldn’t go together. Other moms assume that nothing is wrong since they’re not depressed, just anxious.

Terms and proper diagnoses are so important.

If you work with or are a childbearing woman, please be familiar with different PMADs and their symptoms and differences. The Blue Dot Project has a good page on this, and Postpartum Support International goes into more depth on their info pages (https://www.postpartum.net/learn-more/).

The Overstimulated Parent

I knew babies could get overstimulated. When ours weren’t sleeping well, one of the first things I did was make sure there wasn’t too much going on before their naps and that they had a dark, quiet environment for sleeping. But it took me a long time to realize that most of the times when I snapped at my husband or kids, it wasn’t because I was angry, it was because I was overstimulated. I still shouldn’t have snapped at them, but once I couldn’t address the root properly until I knew what it was. Mom gets overstimulated, too—and it can be just as detrimental as when baby is overstimulated.

Once the worst of my postpartum depression was over, I still felt like my brain was about to explode. Daily life had moved from numbness to panic-like tension. No matter what our routine was, how I reduced stress, or how much sleep I got, I constantly felt like managing simple responsibilities was like shoving a square peg into a round hole. Some of the irritability[1] and inability to focus was just a symptom of depression. But in the four years since that bout of PPD, I’ve realized that a large portion of it was also overstimulation.

I should have known sooner that I was easily overstimulated: youth group was often stressful for me, and I skipped the singing time at youth conferences because it was too loud, too crowded, too much. I pick up on details quickly, which can be nice, but also means that there’s often too much in one place for me to really process. It’s overwhelming, and my reaction is often anger or impatience because something just needs to stop.

It’s no excuse for anger, but it’s helped me know what to do instead of getting angry.

1. Remember the problem isn’t anything anyone is doing, but simply that the amount of stimulus has sent me into flight/fight mode. I’m not about to explode. The world isn’t about to end. I’m not forgetting something important. Knowing this helped me be calmer when our third was a baby, because I could tell myself I wasn’t losing my mind; there was just too much going on.
   
2. Take a deep breath: the “there’s just too much!” feeling is very similar to panic, and focusing on deep breaths helps me calm the panic and sort out the various inputs. I’m also usually praying at this point, especially praying that I won’t sin in my overstimulation. Closing your eyes if you can helps, too (or throw an apron over your head like Sarah Edwards ;)).
   
3. Turn down or off whatever stimulus you can. Ask the kids to be quiet or go outside, or leave the room if you can. (I confess that often this has looked like me shouting “STOP!” because all I can think about is there being too much going on). Sometimes I just have to choose to shut out or ignore certain stimuli, filtering out what isn’t important. A lot of people mention turning on peaceful or worship music as a way to dwell on the truth instead of sinking into depression or anxiety. I have done this at night, but if my kids are around, I cannot handle it.
   
4. Deal with what’s going on one thing at a time. Sometimes I make a list for that, other times, each kid gets a turn to say something. It’s been helpful for me to set a timer to blitz through a few things or do a brain dump while my kids watch a video or at least know that they get mommy back when the timer goes off.
   
5. Make low-stimulus time a priority. When our third was little, I extended her last nap of the day by wearing her in the carrier, in a dark bedroom, with white noise on while my husband finished up dinner with the older two. After a few nights of this, I realized that that half an hour was a great help to me. Since then, I’ve found myself taking rests or “naps” and realizing that I’m not actually fatigued, I just needed to let my brain have a break and unwind. Lowering stimuli also means that I have to be careful to not get too wrapped up in a book, podcast, blog article, etc. when the kids are awake or it’s not their rest time, so that if I am interrupted, my brain isn’t already full.

Over time, this has helped me expand my capacity for stimuli. I’m doing better with three kids than I did for a long time with only two, but it’s taken a long time. It’s also harder for me to handle excess stimuli in the Winter, when my seasonal depression is around. But with practice, I’ve learned to identify overstimulation, sort out the stimuli, and try to reduce them so that I can process everything I need to.

(This podcast has some helpful tips, and it’s pretty amazing to hear about all of the different sensory systems God designed).

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[1] Irritability = tendency to be irritated, easily irritated. This is different from the action taken in response, which could be sinful or not. We can be irritable due to sin, but other stressors can lead us that direction as well.

On Being Dependent

Originally posted in September 2019 (I’m not pregnant right now!), but I’m reposting it because I’ve been thinking about these things again recently.

None of us can do life on our own.

But when I’m rested, it’s easy to think that I can, or at least that I can as long as I have Ezra’s help with dishes and bedtime.

Pregnancy, especially the beginning and the end, make it pretty clear that I’m more dependent on God and others than I usually realize. The fatigue of pregnancy is a clear reminder that I am not God. All of the unknowns our of my control are also heavy indicators of this. And depending on the level of exhaustion, it’s easy to throw around the phrase “less human.” And when I start feeling “less human,” that becomes intertwined with not feeling like I am enough. Rather, that I am not doing enough.

Because when we can keep up with (all of, most, some, a few) of our ideals, it’s easy to think that what we do is earning love and worth. That when we can give something back is when we are lovable. Pregnancy (and even more, postpartum!) always brings me face to face with this lie, and living on a smaller budget in the basement “apartment” of Ezra’s parents’ home has also challenged this. More generally, having kids and moving frequently has done that – favors can’t always be returned, and there isn’t always time or opportunity to “earn” people’s help. But in the body of Christ, that’s all lies anyway because that’s not how God loves us. Not that we should be lazy, but that our worth and loveliness does not come from anything we do for God or others but completely by grace.

So I’ve learned to take free food or accept extra babysitting or a ride or kids’ clothes without any burden of feeling I have to do something in return. But it’s also been amazing to see places where I have been able to pour into the community – not necessarily back to the same people who have helped us, but others in the Body – in a way that points to the interdependence of God’s people. The same month we were given 13 newborn cloth diapers, we found a home to give away the booster seat that had never sold on craigslist. As believers, we should not have a log of who did what for me that I need to repay or who I’ve done things for that I can go to for help. It’s about grace and sharing freely what God has given us. Dependence.

This dependence does not make us “less human.” Having a low-functioning brain from being sleep deprived also does not make me “less human.” You are never more or less human.
Aubry Smith writes in Holy Labor (and this applies beyond pregnant women!), “Women are made strong because God has created them in his image. Women have limitations because they are human and not God (or goddesses!). Once we embrace our humanity, we are free to enjoy the strength God gives us and revel in the Sabbath rest given to us by our loving creator” (58).
So we can sleep with tasks unfinished, ask for help from people we hardly know, and receive support without shame. This is hard for all humans because of pride (we want to be gods! See “Humble Roots” by Hannah Anderson). But the popular narrative of pregnant women as “goddesses” can make this even harder for mothers.

Smith writes, “While I was physically stronger, the mother goddess narrative also loaded guilt and shame on me when I felt the limitations of my own body. Pregnant mothers do have limits, and the limitations are greater than the limitations on bodies of non-pregnant women… As I neared labor, my so-called inner goddess couldn’t be paged. I was coming to terms with my own humanity. These books left me almost unable to admit my creaturely weaknesses and limitations. And I still had postpartum ahead of me! I felt as if I lived in a paradox: a pregnant woman is strong, and a pregnant woman is weak” (45).

Like it or not, as humans we are dependent. When we are strong by God’s grace, others depend on us. And when we are weak, we by God’s grace depend on others. Either way, we are all the while recipients of His grace and hesed – a word that doesn’t fully translate into English but that Michael Card summarizes as “when the person from whom I have a right to expect nothing gives me everything.”

May we as members of the body of Christ, pregnant or not, weak or strong, fully receive His free grace, bestow it uncalculatingly on others, and receive it without burden.

Accounting for Sin and the Curse

One of the things that makes talking about mental health difficult as Christians is that we have to account for both sin and the curse.[1] To ignore either is reductionistic. We are sinners, and our sin can contribute to our lack of mental health. But we also live in a world that is broken. Life is full of thorns and thistles, futile work, and conflict not directly related to our sin.

The difficulty is that we can’t always tell where the curse ends and sin begins.[2]

Sometimes we do all we can to address the physical aspects of our suffering and still find ourselves face-to-face with sin in our lives and a fallen world. Sometimes we struggle because on this side of the New Heavens and New Earth, there will always be thorns and thistles. Sometimes our sin needs to be vigorously attacked. Sometimes, “It was not that this man sinned, or his parents, but that the works of God might be displayed in him” (John 9:3).

How do we differentiate between various causes? Can we? Should we?

It’s hard, but we should acknowledge both sin and the curse as potential factors and address both where appropriate as we discern each individual’s situation.

Ed Welch notes how necessary this is: “If we confuse physical for spiritual symptoms, we are liable to hold people morally responsible for physical symptoms. …If we confuse spiritual for physical symptoms, we are liable to excuse sin or have little hope for spiritual growth when someone has a psychiatric diagnosis.”[3] Even so, not every spiritual symptom is sin-related. As Zack Eswine writes in Spurgeon’s Sorrows, “Though sins can result from it and temptations intensify because of it, depression itself is not a sin… Sometimes what threatens God’s absence in our life is not our hard heart but a physiological prankster.”[4]

What happens in our bodies affects our mental health and how we address distress. If the root of a problem is nutritional deficiencies, thyroid imbalances, hormones, or other physical and circumstantial factors, counseling is good. Yet you can make use of all the counseling you can get and while you may learn to struggle well, you’ll still be struggling because the root cause has not been helped. This was true of my perinatal anxiety in 2019: the counseling, prayer, and other “soul-work” I did helped me fight it well, but did nothing to alleviate the frequency and intensity of the anxiety. But at three months postpartum—right at the end of the “fourth trimester,” after 9 months of wrestling anxiety—it vanished without me changing anything. The same is true of my seasonal depression. I seem vastly more sanctified in April than I do in February, but the change has nothing to do with suddenly becoming more holy and everything to do with temperature and sunlight (if anything, I coast through the warmer months, growing lazy about my sin because it’s less blatant).

But to say that depression and other mental illnesses are not sinful in and of themselves doesn’t mean that sin is never a factor. If you’re depressed due to idolatry, medication and lab work won’t help. Sin can’t be medicated. Likewise, there have been times when my anxiety stems from blatantly sinful things, like attempting to be God by trying to take control. In other cases, our sin feeds and worsens physiological and circumstantial factors.

There are also times when mental health exacerbates sin without one causing the other. According to Ed Welch,

 “Physical symptoms test our hearts and expose them. This is different from saying that the physical symptoms caused these heart issues. They might accompany them rather than cause them. It is as if the pressure of difficult circumstances pushes the true condition of our heart to the surface. When the depressed person deals biblically with these issues, she is freed to grow in faith and obedience.”[5]

Welch continues, “Will the depression be alleviated by dealing with these issues of the heart? We have no guarantees from Scripture.”[6]  The complexity of our humanity and the world around us means that we must replace simplistic answers with careful counsel.

With both sin and the curse in mind,

“Whether a person takes psychiatric medication or not is not the most important issue. Scripture is especially interested in why someone is taking medication or why someone is not taking medication. And it is clear that medication is never the source of our hope. With these guidelines in mind, there is biblical freedom to try, not try, psychiatric medication.”[7]

However we address the roots of our mental illnesses, we cannot let mental ill-health excuse sinful behavior. In other words, while we push back on the curse, we must also let our suffering sanctify us, whether the suffering stems from our sin or not. We can glorify God even when anxiety, depression, OCD, and more assail us. While I benefited from the sanctification they brought, my PMADs were not caused by my sin. They did not go away because I “outgrew” them and was sanctified beyond them. But in them I did have to fight my sin. When overstimulated, I had to tame my tongue. When anxious, I had to dwell on what was true about God and what was real—not my imaginings.

Whether it’s caused by our sin or the curse, God is at work in our mental health struggles. And His work extends beyond our sanctification. Mike Emlet writes, “Don’t be too quick to cast off suffering as though immediate relief from trials is the only good God is up to. And don’t think it’s more “spiritual” to refrain from taking medications, as though character refinement through suffering is the only good God is up to.”[8]

Christians cannot be reductionistic in our approach to mental health. God is doing more in our lives than we can see. The psychosomatic unity of our humanity—that we are embodied souls—cannot be ignored. Both our bodies and souls must be considered. Likewise, sin and the curse must both be taken into account as we seek to alleviate suffering. We may not be able to tell exactly where the curse ends and sin begins, but we can carefully, compassionately work to address both.

Life in a fallen world means that even when mental illnesses are healed, life will not be easy. On this side of glory, we’ll never see an absence of sin in our lives or be free from internal and external malfunctions and brokenness. But one day— “He will wipe every tear from their eyes. There will be no more death or mourning or crying or pain, for the old order of things has passed away” (Rev. 21:4). He is making all things new, and that all things includes us and our mental health.

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[1] Genesis 3:14-19. While there are aspects of sin in the curse, here I am using it to refer to the difficulty and futility of life that enters the world after the Fall.

[2] This exact wording comes from my husband, Ezra Dunn.

[3] Ed Welch, Blame it on the Brain (P&R Publishing, 1998), 119

[4] Zack Eswine,  Spurgeon’s Sorrows (Christian Focus Publications, 2014), 37

[5] Ibid,124

[6] Ibid, 124

[7] Welch, 112. We also have to keep in mind that “There is no evidence that these drugs treat a specific chemical deficiency that causes depression in people, but there is evidence that these drugs can change some depressive symptoms in some people.” (Welch, 125)

[8] https://www.desiringgod.org/articles/prozac-and-the-promises-of-god